Oscar's blood work is back - need eyes!!

[Kelly & Oscar]

We had to go back into the vet yesterday afternoon to draw more blood since they didn't have enough to complete the PCR test for hemobart.

We might know about the hemobart test by this afternoon..... it might be Monday though. Below is a list of the values from Feb that were outside the normal range and the current values that are outside the normal range.

For the latest blood work there was a comment at the bottom stating: "There was less than 0.5ml of blood in the CTT. Excess EDTA may mildly reduce the HCT resulting in false MCHC elevation. Blood smear reviewed by technologist."

.................Feb.......Oct........Range....out of range now?
ALT............184........115......(10-100)....**HIGH**
Alkaline
phosphatase...114........66.......(6-102)
Magnesium.....1.4.......1.9.......(1.5-2.5)
Sodium.........150.......153.......(145-158)
Potassium......4.3.......4.9.......(3.4-5.6)
Na/K ratio.....35 ........31........(32-41)..... **LOW**
Cholesterol....228........247.......(75 - 220)...**HIGH**
WBC...........8.2.........5.9.......(3.5-16.0)
RBC............8.8........5.9.......(5.92-9.93)...**LOW**
HGB..........13.3........11.5......(9.3-15.9)
HCT...........39..........25.......(29-48)......**LOW**
MCHC.........35......... 46........(30-38)......**HIGH**
(comment added for OCT: anisocytosis +2)
Neutrophilis..5494.......4602......(2500 - 8500)
Lymphocytes..1148.......590......(1200-8000)..**LOW**
Monocytes.....820........236......(0-600)
Eosinophilis....738........472......(0-1000)
Basophilis.......0 ..........0........(0-150)
Platelet est...increased...adequate
plat. count....760........452......(200-500)

Everything tested negative on the urinalysis.

Urine Specific Gravity 1.035 (1.015 - 1.060)
PH 6.5 (5.5-7)

..........FEB.......OCT...... RANGE
BUN.....21.........28........(14-36)
Creat...1.0........1.3........(0.6-2.4)
Phosph..3.1........3.1........(2.4-8.2)

Since our foster kitty, Yoda, just went through anemia caused by hemobartonella, we are currently running a test for Oscar to see if he has the same mycoplasma.

I have been reading about low lymphocytes, and they say that stress can cause slightly low values (could explain the values from FEB). I know systemic steroids can cause low values, but his Flovent isn't systemic. Very very little actually gets in the blood stream, so I don't think that would cause such low values. Another cause could be acute infection.

I found this about anisocytosis:

Anisocytosis means that your red blood cells are unequal in size. In most cases there will be a few undersized or oversized blood cells and this is normal. When they note a number such as +2 anisocytosis, this means that there are unusually large numbers of this condition and that sometimes is flagged regarding a blood disease. It could be from anemia, bone marrow failure, or from transfusions of extra blood cells.

 

[Jill and Remi]

Bloodwork really baffles me. I mean I can read when things are too low or too high but I never know why it is that way. I know I am not helping but I will be thinking of you and Oscar and hoping you get an answer soon.
I do know my civie, Phoebe, had low wbc and the vet never could figure out why. All of the follow up tests came back fine.
Let us know how Oscar is and what the next step is please, when you find out.

 

[Larry and Kitties]

Nothing really stands out except, as you noted, the low HCT and other low red blood cell values. Was there any mention of a reticulocyte (immature red blood cells) count? This is an indicator of if the anemia is regenerative (the body is making enough red blood cells but they are dying or disappearing too fast) or non-regenerative (not making enough). Has the vet check a fecal sample for occult blood to help determine if blood is being lost out the digestive e tract.

 

[Kelly & Oscar]

No reticulocyte count done. From what I have read, the body will generally not respond drastically to mild anemia like this. The counts were normal for Yoda when he was even more anemic than Oscar is now.

No fecal done either. I have never seen bloody poo's though. If the hemobart (PCR) test comes back negative, I will ask about it though.

What is your opinion of the very low lymphocyte count? It has dropped quite a bit in the last 7 months.

 

[Deanie and Boo (GA) and Scout]

.................Feb.......Oct........Range....out of range now?


RBC............8.8........5.9.......(5.92-9.93)...**LOW**
HGB..........13.3........11.5......(9.3-15.9)
HCT...........39..........25.......(29-48)......**LOW**
MCHC.........35......... 46........(30-38)......**HIGH**

These results are not accurate. A hematocrit of 25% does not match with a hemoglobin level of 11.5. Given the elevated MCHC, I would suspect lipemia to the the interference here. Sadly, those 3 results should have been a big red flag to both the person who ran and reported them and to your vet who read them. Further investigation should have been done before reporting results like this. Your hematocrit value should be closer to 34-35%, which is not anemic.

It's also more helpful to post all of the results, not just those that flag out of range. Sometimes you need to see the relationship between 2 values, not just one that may be slightly out of range. Keep in mind that values outside the normal range will not necessarily be abnormal. That RBC count is only 0.02 below the "norm" , which is insignificant.

 

[Kelly & Oscar]

I posted everything that was included in the CBC part of the panel - out of range or not. Since the blood count levels look off, is it possible that the lymphocyte count is off too since it is part of the same panel? Looks like I should ask for them to redo the CBC part of the blood work.

 

[Deanie and Boo (GA) and Scout]

I posted everything that was included in the CBC part of the panel - out of range or not. Since the blood count levels look off, is it possible that the lymphocyte count is off too since it is part of the same panel? Looks like I should ask for them to redo the CBC part of the blood work.

But he has 78% neutrophils, which is probably a stress reaction. Of all his white cells, 78% are neutrophils, 10% are lymphs, 4 % are monos and the remaining 8% are eos. They all have to add up to the total 5900 white count or 100% so if one value goes up, another will naturally go down. It's not something i would really stress over.

I would, however, ask the vet why he didn't notice the hgb/hct discrepancy and what he planned to do to correct it. He also needs to speak to someone at the lab that ran this to see why it was reported this way with no further follow up.

 

[Michele and Esse]

.................Feb.......Oct........Range....out of range now?


RBC............8.8........5.9.......(5.92-9.93)...**LOW**
HGB..........13.3........11.5......(9.3-15.9)
HCT...........39..........25.......(29-48)......**LOW**
MCHC.........35......... 46........(30-38)......**HIGH**

These results are not accurate. A hematocrit of 25% does not match with a hemoglobin level of 11.5. Given the elevated MCHC, I would suspect lipemia to the the interference here. Sadly, those 3 results should have been a big red flag to both the person who ran and reported them and to your vet who read them. Further investigation should have been done before reporting results like this. Your hematocrit value should be closer to 34-35%, which is not anemic.

It's also more helpful to post all of the results, not just those that flag out of range. Sometimes you need to see the relationship between 2 values, not just one that may be slightly out of range. Keep in mind that values outside the normal range will not necessarily be abnormal. That RBC count is only 0.02 below the "norm" , which is insignificant.

Agree with the H/H not matching, and the culprit being lipemia. Note the high reading on cholesterol, as well as the slightly elevated ALT. I really like that the ALT has come down, though, so whatever was pissing off Mr. Liver seems to be working itself out.

BTW, and I don't know the ratio for felines, but in humans, the 3:1 rule is a good one for H/H; that's why Deanie mentioned it. If you look at February's H/H, you'll see the 3:1 ratio pretty clearly. So for it to be skewed like that now, there is something else happening in the count (and lipids floating around would do it).

Also, just to go further on the stool blood, we often don't see it as blood...in humans, we call the test FOB, or fecal occult blood, "occult" meaning 'hidden.' We do it when we suspect some sort of bleed, but it's not "frank" or easily seen in stool. Sometimes labs suggest this, sometimes it's a series of symptoms or signs, and sometimes, it's just something to rule out. So not seeing it doesn't mean it's not happening; it also doesn't mean it is. LOL...just one of those tests that may tell something about what's happening in the digestive system somewhere.

I haven't been following what's going on, so can't comment specifically to that. But just wanted to add some notes. Generally speaking, the panel looks good, except for the cholesterol and the h/h...but again, the h/h seems to be skewed somehow, and the liver may be producing cholesterol all by it's ownself for some reason...

Best-
Michele

 

[Kelly & Oscar]

Well, the results could be skewed. As noted above, they included this note at the end of the CBC results:

"There was less than 0.5ml of blood in the TT. Excess EDTA may mildly reduce the HCT resulting in false MCHC elevation. Blood smear reviewed by technologist."

BUT.... the smear also showed a large number of undersized and oversized RBCs (anisocytosis +2). Could this be due to lipemia too?

Thanks for all the input everyone. Really helps to calm my nerves! :YMHUG:

 

[Larry and Kitties]

Lipemia is fat in the blood. The whole blood tends to look milky if the it is very lipemic. Lipemia can effect machine analysis results such as blood chemistry and automated cell counts. However, it will not effect the results of a person looking at a blood smear under a microscope.

Well, the results could be skewed. As noted above, they included this note at the end of the CBC results:

"There was less than 0.5ml of blood in the TT. Excess EDTA may mildly reduce the HCT resulting in false MCHC elevation. Blood smear reviewed by technologist."

BUT.... the smear also showed a large number of undersized and oversized RBCs (anisocytosis +2). Could this be due to lipemia too?

Thanks for all the input everyone. Really helps to calm my nerves! :YMHUG:

 

[Deanie and Boo (GA) and Scout]

Well, the results could be skewed. As noted above, they included this note at the end of the CBC results:

"There was less than 0.5ml of blood in the TT. Excess EDTA may mildly reduce the HCT resulting in false MCHC elevation. Blood smear reviewed by technologist."

Oh, I overlooked that part earlier. In a nutshell, they sent out a bad sample and you got bad results back from it. The basic saying in most labs is "garbage in, garbage out", meaning you can't get a reliable result off a lousy sample. If I got a sample like that, I most likely wouldn't run it. If I did and got flakey results, I defintiely wouldn't report it. I would ask to have it recollected. I certainly wouldn't charge anyone for it.

The sad part is that they had to have known it was a very short sample when it was drawn in the clinic. The best thing to do would have been to get a fresh needle and stick the cat a 2nd time for a better sample. Sure, it would have meant a 2nd stick but that's better than wasting your time with these lousy results because now you're going to have to take the cat in to be stuck a 2nd time anyway. (and it should be FREE!)

We see the same problem at work all the time. They get a little squirt of blood in a tube and send it off to the lab--they know we call and cancel them all the time but they keep doing it anyway. They don't want to take the time to collect a 2nd sample, even though it will be a better one that will give more accurate results.

Don't worry about the aniso either until you see something off a better sample. That's also very subjective and depends on the education and experience of the person looking at the slide.